Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery

Buzzatti, Nicola; Iaci, Giuseppe; Taramasso, Maurizio; Nisi, Teodora; Lapenna, Elisabetta; Bonis, Michele De; Maisano, Francesco; Alfieri, Ottavio

doi:10.1093/ejcts/ezt638

Cited by 58 publications

(45 citation statements)

References 15 publications

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“…Some researchers reported there were no statistical differences in early and late outcomes between the isolated tricuspid valve repair versus replacement surgery [6]. However, some study shown improved mortality for replacement and in accordance with our results [3]. In our opinion, replacement or repair is decided by the surgeons' comprehensive judgement of patients' states and personal experiences.…”

Section: Discussionsupporting

confidence: 87%

“…However, there are a large population of secondary isolated tricuspid valve regurgitation after previous cardiac operations, they are neglected and undertreated. Because of the low pressure and low resistance of right-side cardiac valves, patients with tricuspid valve regurgitation usually do not have significant symptoms at the early stage and are rarely referred for isolated surgical intervention of tricuspid valve until right heart failure, uncontrolled ascites or edema of lower extremity happened [3,4]. Therefore, isolated tricuspid valve surgery has been reported associated with a high morbidity and mortality [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

Song

Yao

et al. 2020

Preprint

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BackgroundRedo isolated tricuspid valve surgery has been associated with a high morbidity and mortality, and its optimal timing of surgical intervention remains controversial. Hence, we reviewed our early and midterm results with a simplified minimally invasive beating heart technique for isolated redo tricuspid valve surgery in patients at high risk.MethodsBetween June 2016 and August 2017, a total of 14 consecutive patients underwent isolated tricuspid valve operations after previous cardiac operations with minimally invasive beating heart technique through a right lateral thoracotomy in our center. Mean patient age was 54.0 ± 8.3 years, and 9 patients (64.3%) were women. Mean preoperative EuroSCORE was 8.1 ± 1.3 (6 to 11). Previous cardiac operations included 6 patients (42.9%) with mitral valve replacement, 1 patient (7.1%) with mitral valve replacement and tricuspid valve repair, 1 patient (7.1%) with tricuspid valve replacement, 5 patients (35.7%) with mitral valve and aortic valve replacement, and 1 patient (7.1%) with Ebstein repair. Midterm follow-up was complete for 12 patients (85.7%).ResultsBoth in-hospital and thirty-day mortalities were 0%. Tricuspid valve replacement with bioprosthesis was performed in 12 patients (85.7%), and the remaining 2 patients (14.3%) underwent tricuspid repair (annuloplasty and leaflets reconstruction). Mean cardiopulmonary bypass time was 55.6 ± 10.7 minutes. Overall in-hospital duration and intensive care unit (ICU) time were 11.6 ± 8.8 days, 3.9 ± 2.8 days, respectively. Postoperative complications included 2 patients (1.4%) with prolonged ventilation, and 2 patients (1.4%) with acute kidney injury. There were no postoperative cerebrovascular accidents, myocardial infarctions, reoperations for bleeding, or deep wound infections. All patients were discharged uneventful. Except 2 patients lost follow-up, there were no adverse cardiovascular events and deaths occurred in other patients.ConclusionsSimplified minimally invasive beating heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

Song

Yao

et al. 2020

Preprint

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“…While our 17.6% rate of residual TV regurgitation in the replacement group is relatively high, it is within range of the few studies in the literature that report this information. Buzzatti et al and Pfannmuller et al reported residual TV regurgitation in 13.9% and 17% respectively after TV replacement (3,6). The reasons for this are unclear and could be due to failure or improper remodeling of the RV geometry after TV replacement.…”

Section: Comparison Of Outcomesmentioning

confidence: 98%

“…The literature on isolated TV operations is sparse and historically associated with high mortality rates (3,4). This is especially true in the setting of right ventricular failure (4).…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

Ejiofor

Neely

Yammine

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Isolated tricuspid valve (ITV) operations are infrequent and the decision to operate is controversial. We report a series of ITV operations to outline the current disease status requiring this uncommon procedure with an emphasis on the results of tricuspid valve repair (TVr) versus replacement (TVR).Methods: Using our prospective cardiac surgery database, 57 patients who underwent ITV operations between 01/02-03/14 were identified. Median follow up time was 3.5 years [interquartile range (IQR), 0.8-6.7 years].Results: Fifty-seven patients underwent ITV surgery with a mean age of 54.4±14.9 yrs and 61% were women. Baseline characteristics were similar between patients who underwent TVr (n=18) or TVR (n=39).The etiologies of TV dysfunction were: ITV endocarditis 14/57 (25%), persistent TV regurgitation after left-sided valve surgery in 12/57 (21%), traumatic biopsies and iatrogenic injury from pacing leads in 11/57 (19%), orthotopic heart transplant 9/57 (16%), carcinoid syndrome 3/57 (5%), congenital 2/57 (5%) and idiopathic 5/57 (9%). Overall, 32/57 (56%) patients had prior heart surgery; of which 10/32 (31%) were TV procedures. Bioprosthetic prostheses were used in 34/39 (87%) patients. Of those who had repair, 11/18 (61%) had ring annuloplasty, 3/18 (17%) bicuspidization, and 3/18 (17%) De Vega annuloplasty and one had vegetectomy. Operative mortality was 5.1% (n=2) and 16.7% (n=3) for TVR and TVr groups, respectively (P=0.32), with an overall mortality rate of 8.6%. Postoperative complications included new onset renal failure in 6/39 (15%) of TVr and 2/18 (11%) of TVR (P=0.71) and there were no strokes. Overall survival rates and degree of residual RV dysfunction were similar for the two groups (both P=0.3). Five-year survival was 77% and 84% for TVr and TVR respectively (P=0.52). There was no difference in rates of recurrent tricuspid regurgitation for TVr and TVR (35.7% vs. 23.5%, respectively, P=0.4).Conclusions: ITV surgery is associated with improved but still relatively high operative mortality. Midterm outcomes for TVr and TVR are similar with regards to postoperative complications, survival, and freedom from recurrent tricuspid regurgitation.

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“…The predominant causes of mortality are low cardiac output syndrome and persisting heart failure. The major factors limiting survival are the preoperative condition of the RV and the severity of secondary renal and hepatic impairment [9,20,21]. The only way to improve the clinical outcomes is an earlier surgical indication, before the occurrence of RV dysfunction.…”

Section: The Issue Of Late Tricuspid Regurgitation Following Previousmentioning

confidence: 99%

Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes

Pozzoli

Lapenna

Vicentini

et al. 2016

Gen Thorac Cardiovasc Surg

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The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

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Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery

Cited by 58 publications

References 15 publications

Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes

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